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    Your attorney has asked that I conduct a psychological assessment in connection with your court case. This form was written to give you information about the assessment process. The assessment usually contains two parts, an assessment interview and psychological testing. During the interview I will ask you questions about yourself and/or anyone else that may be relevant to your case. There may be topics that you may not wish to talk about. If there are, please let me know and I will ask no further. We can also talk about any concerns that you have.

    During the interview I may not ask about some areas of information that you believe are important. Please let me know so that we can discuss them. I may also obtain what is called collateral information form friends, relatives, or other people including employers or school personnel regarding your case. Please let me know if you have any objections.

    I am a psychologist licensed by the State of Florida. I am also Board Certified in Clinical Psychology. You may feel free to ask your lawyer for a copy of my resume.

    Please check each item below to indicate that you have read this form and understand it:

    • I understand that Dr. Wade H. Silverman has been hired by my attorney,
      to conduct a psychological assessment and a clinical interview.
    • I understand that Dr. Wade H. Silverman will write a formal report about me based on the results of his assessment.
    • I authorize Dr. Wade H. Silverman to send a copy of this formal report to my attorney and to discuss the report with him or her.
    • I understand the Dr. Wade H. Silverman will not provide me with the written report but I may, if I choose, obtain it from my lawyer.
    • I authorize Dr. Wade H. Silverman to testify about me and this assessment in depositions and trial(s) related to my legal case.
    • I understand that if I disclose certain types of special information to Dr. Wade H. Silverman, he may be required or permitted to communicate this information to other people. As previously discussed with Dr. Wade H. Silverman, examples of such special information include reports of child or elder abuse and threats to kill or violently attack a specific person.

    If you have read, understood, and checked off each of the prior actions, please read carefully the following statement and, if you are in agreement, please sign the statement.

    Do not sign if you have any further questions or if there are any aspects that you don’t understand or agree to: contact your attorney for guidance concerning how to proceed so that you fully understand the process and can decide whether you wish to continue.

    Consent Agreement: I have read, agreed to, and checked off each of the previous sections. I have asked questions about any parts that I did not understand fully. I have also asked questions about any parts that I was concerned about. By signing below, I indicate that I understand and agree to the nature and purpose of this testing, how it will be reported, and to each of the points listed above.